BACKGROUND AND OBJECTIVES: Chronic pruritus (CP) and chronic prurigo (CPG, including prurigo nodularis) are prevalent, debilitating diseases with diverse comorbidities, including malignancies. This retrospective cohort s...BACKGROUND AND OBJECTIVES: Chronic pruritus (CP) and chronic prurigo (CPG, including prurigo nodularis) are prevalent, debilitating diseases with diverse comorbidities, including malignancies. This retrospective cohort study evaluated the prevalence and risk of lymphoma in CP and CPG patients, including key risk factors, and sex- and ancestry-related disparities. PATIENTS AND METHODS: We utilized electronic health records from the TriNetX US Collaborative Network (2011-2024), including 1,032,281 CP and 124,611 CPG patients (without prior lymphoma), matched to non-CP/non-CPG controls. Lymphoma risk was evaluated up to 5 years post-diagnosis. Sensitivity, sex- and ancestry-stratified analyses were performed. Multivariate analyses identified risk factors. RESULTS: Lymphoma developed in 0.29 % of CP (controls: 0.10 %, HR 2.90, 95 % 95 % CI: 2.71-3.12) and 0.30 % of CPG patients (controls: 0.10 %, HR 2.85, 95 % CI: 2.33-3.48; both p < 0.0001). The HR for cutaneous lymphoma was 6.62 (95 % CI 5.02-8.72) for CP and 10.95 (95 % CI 4.39-27.35) for CPG (p < 0.0001 each). Findings remained robust across all sensitivity analyses. Significant lymphoma risk factors included elevated serum lactate dehydrogenase, beta 2-microglobulin, male sex, immunosuppressant use, and White ancestry. CONCLUSIONS: CP and CPG patients have an increased lymphoma risk, linked to specific biomarkers, highlighting the importance of increased clinical vigilance in their management.
While there has been significant progress in the development of new therapies for psoriasis and atopic dermatitis in recent years, innovation in the field of type 1 dominant skin diseases is still limited. This category...While there has been significant progress in the development of new therapies for psoriasis and atopic dermatitis in recent years, innovation in the field of type 1 dominant skin diseases is still limited. This category comprises diseases characterized by a cytotoxic immune reaction directed against resident skin cells. The histological correlate is interface dermatitis, defined by a subepidermal inflammatory infiltrate associated with epidermal keratinocyte apoptosis. Representative conditions include lichen planus, cutaneous lupus erythematosus, erythema multiforme, alopecia areata, and vitiligo. Immunologically, there is a dominance of Th1 cells, which mediate their effects through interferon-γ and tumor necrosis factor-α. Recent findings have shown that, in addition to apoptosis, other forms of cell death are also activated by this immune response, such as necroptosis. In contrast to apoptosis, necroptosis represents a strong immunological stimulus and thus further intensifies the local inflammatory response. These findings open new therapeutic perspectives, as numerous necroptosis inhibitors are currently under investigation for various inflammatory diseases. The present review summarizes the immunopathogenesis of type 1-dominant skin diseases and highlights emerging therapeutic strategies, including the inhibition of inflammatory cell death.
BACKGROUND AND OBJECTIVES: AI-based image analysis is increasingly applied in pathology. Excluding fungal elements in PAS-stained skin sections is labor-intensive and well suited for AI assistance. While fungal detection...BACKGROUND AND OBJECTIVES: AI-based image analysis is increasingly applied in pathology. Excluding fungal elements in PAS-stained skin sections is labor-intensive and well suited for AI assistance. While fungal detection in nails has been studied, skin-biopsy applications and real-world benefit remain limited. This study aimed to develop an AI algorithm for fungal detection in skin histology, create intuitive visualization software, and assess its diagnostic utility for pathologists. PATIENTS AND METHODS: A total of 466 PAS-stained cases from four institutions were digitised using three scanners. A lightweight UNet-based model was trained with semi-supervised learning and hard negative mining. Six dermatopathologists reviewed 204 independent cases in two phases: first without then with AI after a 4-week washout. Inter-observer agreement, diagnostic time, and AI-human concordance were recorded; ROC analysis assessed algorithm performance. RESULTS: The AI demonstrated strong correlation with human assessment (ROC-AUC up to 0.949). At least one pathologist agreed with AI in 91.2% of cases. AI assistance increased Fleiss' kappa from 0.67 to 0.82, raised full agreement from 64% to 78%, and halved diagnostic time, especially in negative cases. Software-usability scored 9.5/10 and integration willingness 8.3/10. CONCLUSIONS: AI assistance improved accuracy, reduced reading time, and offered user-friendly visualization, supporting integration into diagnostic workflows.
BACKGROUND: Artificial intelligence (AI) algorithms have advanced and recently shown high accuracy in diagnosing skin cancer from dermoscopic images. This study compared the diagnostic performance of the large language m...BACKGROUND: Artificial intelligence (AI) algorithms have advanced and recently shown high accuracy in diagnosing skin cancer from dermoscopic images. This study compared the diagnostic performance of the large language model ChatGPT-4 with that of specialized convolutional neural network (CNN)-based models in analyzing melanocytic lesions. PATIENTS AND METHODS: A cross-sectional comparative study was conducted using 117 dermoscopic images. The performance of ChatGPT-4 was assessed under two conditions: diagnosing lesions directly without annotations and diagnosing after annotating dermoscopic features. Results were compared with CNN-based models (YPSONO and ResNet) and human expert evaluations. The confusion matrices of all the models were calculated in addition to the diagnostic accuracy, sensitivity, specificity, and interobserver agreement (Cohen's Kappa). RESULTS: ChatGPT-4 achieved 92 % sensitivity, 89 % specificity, and an accuracy of 89.7 % in direct diagnosis. When annotations were required, sensitivity and specificity dropped to 68 % and 64 %, respectively. Agreement with experts on dermoscopic patterns was minimal (Cohen's Kappa = 0.13). ChatGPT-4 outperformed CNN models in direct diagnosis but exhibited notable limitations in describing dermoscopic features. CONCLUSIONS: ChatGPT-4 demonstrated promising potential for accurate melanoma versus nevus classification without annotations, surpassing CNN-based models. However, its limited ability to describe dermoscopic features accurately highlights the need for further research and training.
Extramammary Paget's disease is a rare cutaneous malignancy. Although most patients exhibit a favorable prognosis, those with metastatic extramammary Paget's disease typically face poor outcomes, necessitating effective...Extramammary Paget's disease is a rare cutaneous malignancy. Although most patients exhibit a favorable prognosis, those with metastatic extramammary Paget's disease typically face poor outcomes, necessitating effective therapeutic strategies to improve survival and disease management. Due to the rarity of this condition, no standardized treatment consensus exists for the disease. In this review, we summarize current treatment modalities for metastatic extramammary Paget's disease, including chemotherapy, hormonal therapy, targeted therapy, immune checkpoint inhibition, and several emerging novel therapies, which demonstrate variable disease control rates and survival outcomes. Additionally, we explore the potential of promising therapeutic approaches for future applications. Further large-scale clinical studies and well-designed therapeutic trials are required to establish optimal treatment regimens.
Zeyen C, Abeck D, Becker K
… +8 more, Dissemond J, Kahle B, Lorenzen HP, Löffler B, Maier-Hasselmann A, Mittank-Weidner T, Nast A, Sunderkötter C
J Dtsch Dermatol Ges
· 2026 Jun · PMID 41919364
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Infected interdigital intertrigo is an exudative, macerating, mixed infection of the toe webs in which gram-negative bacteria (Pseudomonas aeruginosa and Enterobacterales) seem prevalent, but in which gram-positive patho...Infected interdigital intertrigo is an exudative, macerating, mixed infection of the toe webs in which gram-negative bacteria (Pseudomonas aeruginosa and Enterobacterales) seem prevalent, but in which gram-positive pathogens (Staphylococcus [S.] aureus, streptococci, enterococci) and fungi (dermatophytes, yeasts) also occur. The former German term "gram-negative foot infection" misleadingly implied a soft-tissue infection of the foot caused by gram-negative bacteria. The updated term "infected interdigital intertrigo" is an internationally used designation, as is the term "gram-negative toe web infection". This superficial infection may yet progress to soft tissue infection (phlegmon, cellulitis) of the foot but in immunocompetent patients is usually caused by S. aureus. Complicated courses, as well as the development of interdigital intertrigo itself, are facilitated by diabetes mellitus, polyneuropathy, and peripheral arterial disease. Diagnosis is made clinically, based on painful macerated erosions or ulcers with yellow-green exudate, putrid odor and edema. Superficial swabs are not always diagnostically required or relevant. Management focuses on local therapy with anti-inflammatory, antiseptic, antimycotic agents, dry wound care and reduction of edema. Systemic antibiotics are indicated only in cases of associated soft-tissue infection, which in immunocompetent patients present as uncomplicated cellulitis and therefore require coverage limited to S. aureus. Early vascular evaluation, imaging and surgical assessment in cases of deep infection or necrosis are essential.
BACKGROUND AND OBJECTIVES: Pruritus is a frequent cutaneous immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICI), impacting patients' quality of life. This study investigates the inciden...BACKGROUND AND OBJECTIVES: Pruritus is a frequent cutaneous immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICI), impacting patients' quality of life. This study investigates the incidence, severity and management of pruritus in melanoma patients treated with ICI. PATIENTS AND METHODS: Clinical data from 461 melanoma patients at the University Hospital of Zurich were analyzed in a retrospective, monocentric study. Patients received ICI either as combination therapy (ipilimumab and nivolumab) or monotherapy (nivolumab or pembrolizumab). RESULTS: Immune-related pruritus (irPruritus) was associated with increased overall survival. It affected 23.0 % of patients (106/461), with a significantly higher frequency and earlier onset observed in combination therapy compared to monotherapy (p < 0.001). A significant, pronounced increase in eosinophil counts was noted from baseline to onset of irPruritus. Topical steroids proved effective in 90.9 % of cases. Additionally, irPruritus was significantly correlated with both irFatigue (p < 0.01) and irRash (p < 0.001). CONCLUSIONS: Pruritus is a common side effect of ICI therapy. Its correlation with irFatigue and irRash highlights the broader systemic impact impairing patients' quality of life. Further prospective studies are needed to elucidate the underlying mechanisms such as involvement of eosinophils and identify optimal treatment strategies while maintaining ICI effectiveness.
BACKGROUND AND OBJECTIVES: The Hospital de la Magdalena, a care home for female prostitutes with venereal diseases, operated in Barcelona from 1923 to 1959. The purpose of this investigation is to highlight how this hosp...BACKGROUND AND OBJECTIVES: The Hospital de la Magdalena, a care home for female prostitutes with venereal diseases, operated in Barcelona from 1923 to 1959. The purpose of this investigation is to highlight how this hospital was used to educate female prostitutes morally in addition to providing medical treatment. PATIENTS AND METHODS: We analyzed contemporary reports of the Spanish and the Catalan organization for fighting venereal diseases as well as contemporary articles in both medical journals and in local newspapers. To examine these sources, we implemented the historical-critical method. RESULTS: Female prostitutes from Barcelona and its neighboring towns were isolated and treated as inpatients at the Hospital de la Magdalena. They were admitted by force and against their will without legal basis. An educational program was established in the hospital to rehabilitate the patients. CONCLUSIONS: The Hospital de la Magdalena was not only a medical institution, but also a disciplinary authority. Attempts to re-educate female patients whose lifestyle did not correspond to the traditional Catholic image of women can be documented for the entire study period. There was no comparable institution in Western or Central Europe at the time.
BACKGROUND AND OBJECTIVES: Teledermatology has become an essential part of dermatological care, although challenges in its implementation remain. We conducted a real-life survey on video consultations over a one-year per...BACKGROUND AND OBJECTIVES: Teledermatology has become an essential part of dermatological care, although challenges in its implementation remain. We conducted a real-life survey on video consultations over a one-year period to assess satisfaction and identify barriers. MATERIAL AND METHODS: A monocentric, questionnaire-based study was conducted, using a self-developed questionnaire and the German adaptation of the validated Client Satisfaction Questionnaire. RESULTS: Of 250 scheduled consultations, 89.6% were completed. A total of 128 patients and 13 physicians participated in the survey. The majority of patients (94.5%) and physicians (94.7%) would recommend video consultations. Patients reported high levels of satisfaction, with 93% rating ease of use positively and 80.4% reporting a positive overall experience. Physicians reported high satisfaction, with 98% providing positive feedback regarding scheduling, 94.7% regarding ease of use, and 90.8% regarding overall experience. Feedback on connection stability and skin assessment varied, with connectivity issues correlating with poorer skin findings (p < 0.001). Feedback regarding connection stability and adequacy of skin assessment showed variability. Connectivity issues were significantly associated with poorer dermatologic assessment (p < 0.001). Physicians who were dissatisfied with the quality of skin assessment were less likely to recommend video consultations (p < 0.001) and reported a less favorable overall experience (p < 0.001). CONCLUSIONS: Video consultations can improve access to dermatologic care, patient and physician satisfaction, and efficient use of healthcare resources. Our real-world data show high acceptance among patients and physicians while highlighting areas for optimization, particularly video quality and adequacy of dermatologic assessment.